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Case: 19 year old with back pain

 
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Case: 19 year old with back pain - August 14, 2006 8:54:00 AM   
Dr.Wagner


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A 19 year old female presents with back pain for 2 days. She is a college student at the local university that has recently moved into the dorms prior to the beginning of classes.

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Dr. Wagner DO
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Re: Case: 19 year old with back pain - August 14, 2006 11:16:00 AM   
USAPT

 

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Was it sudden onset?
Recall how it happened?
Where is the pain?
Is is sharp, dull, achy?..localized?
Is it getting better/worse since injury?
What makes it better/worse?..change w/ movements?

okay, i'll stop for now and wait for a response.

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Jason, PT
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Re: Case: 19 year old with back pain - August 14, 2006 12:34:00 PM   
Shill

 

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PMH and back/neck pain history please.

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Steve Hill PT

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Re: Case: 19 year old with back pain - August 14, 2006 12:35:00 PM   
Dr.Wagner


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The pain is "dull", but there are "sharp" aspects as well. It seems to encompass the lumbar region, specifically T10-L3.
She woke up with it two days after moving into the dorms.
Does it change with movement...she states "I have had to lay on my side most of the day"

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Dr. Wagner DO
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Re: Case: 19 year old with back pain - August 14, 2006 2:29:00 PM   
USAPT

 

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meds?
is it getting better or worse?

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Jason, PT
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Re: Case: 19 year old with back pain - August 14, 2006 2:37:00 PM   
USAPT

 

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meds?
is it getting better or worse?

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Jason, PT
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Re: Case: 19 year old with back pain - August 14, 2006 4:10:00 PM   
Jeffre

 

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Does her back hurt the next day after she drinks alchohol alot? Sexually active? Any other students in the dorm have similar problems?

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Re: Case: 19 year old with back pain - August 14, 2006 6:20:00 PM   
Synergy

 

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Well, she just moved in two days prior to the onset of pain so one can assume she was carrying a bunch of objects...perhaps some heavy objects carried improperly (poor mechanics). Did she have to take the stairs...lugging all her stuff? Prior instances of LBP, menstrual problems, etc.

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Chris Adams, PT, MPT

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Re: Case: 19 year old with back pain - August 14, 2006 7:42:00 PM   
jma

 

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On which side of her back is the pain located? Is it localized or is it diffused? On which side does she sleep on? Does the pain aggravate with eating?

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Re: Case: 19 year old with back pain - August 14, 2006 10:20:00 PM   
eam

 

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Is she pregnant? Is she a gymnast, dancer? What makes it worse? Body type? Has she self administered ice or taken OTC meds and if so, did they help?
Erica

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Re: Case: 19 year old with back pain - August 15, 2006 2:13:00 AM   
Randy Dixon

 

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If this patient came into a PT clinic I think we'd find some of what we are looking for in a typical examination. Reflexes, ROM, restrictions, other complaints. First things first, I'd want to know her vitals, look for things like high temperature, abnormal BP, signs of flu or illness, HR, observe her eyes, ask about BM's etc. Then I'd palpate the abdomen, looking for tenderness or hardness. Same with the painful area, looking for redness, heat, swelling, tenderness, bumps, bruises, etc.


Once I get an idea if it is musculoskeletal or something else I'd go from there.

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Re: Case: 19 year old with back pain - August 15, 2006 4:58:00 AM   
nari

 

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Don't mean to sound flippant but what is her mattress like?
If she has gone from a comfy home bed to a dubious mattress in a dorm, the thoracolumbar region may not like it...

Nari

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Re: Case: 19 year old with back pain - August 15, 2006 6:19:00 AM   
Sebastian Asselbergs

 

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Kidney or liver function? (IN addition to all the above - reasonable and common history questions)

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Re: Case: 19 year old with back pain - August 15, 2006 9:33:00 AM   
srcase

 

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does it hurt after or before eating?

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Re: Case: 19 year old with back pain - August 15, 2006 4:52:00 PM   
jbird007

 

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Doc Wags said: "she states "I have had to lay on my side most of the day"


This grabs my attention. My questions would focus here for a bit. :)

Is this so severe that she has serious difficulties walking? How intense is the pain?

I would first try and rule out all the serious complications such as ectopic pregnancy,kidney stones/infection, internal bleed, other visceral disorders, vertebral compression fracture(yes, young thin females are a risk for osteoporosis), etc.


JBird

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Re: Case: 19 year old with back pain - August 21, 2006 1:59:00 PM   
Dr.Wagner


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I apologize for the wait...my computer crashed so I had to buy a new one.

Anyway,
vitals temp 100,HR 90,BP 110/75, rr17
she notes the pain is sharp and any palpation on that side causes pain, including movement to that side.
She states, that while "I did very little in the moving process" she was "much more sore when she woke up the next day...even a little nauseated"

Her mattress is from Costco...other than that she knows very little about it.

A blood test is ordered
Creatinine is .8
BUN 11
K 3.6
Na 136
Cl 106
CO2 25
Glucose 90

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Dr. Wagner DO
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Re: Case: 19 year old with back pain - August 22, 2006 6:34:00 AM   
Sebastian Asselbergs

 

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Doc Wagner, I tried to find IF you had mentioned which side - can't see it anywhere. Could be significant (i.e. spleen - liver etc.). I'll try to make sense of the lab results....

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Mundi vult decipi

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Re: Case: 19 year old with back pain - August 22, 2006 1:53:00 PM   
Dr.Wagner


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right side of thoraco lumbar junction

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Dr. Wagner DO
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Re: Case: 19 year old with back pain - August 22, 2006 2:39:00 PM   
USAPT

 

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nausea, back pain worse next morning, lifting, pain with movement to that side...check for hernia?

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Jason, PT
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Re: Case: 19 year old with back pain - August 22, 2006 3:54:00 PM   
Sebastian Asselbergs

 

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Did she drink lots (ETOH of course) the first few days following the arrival at college?

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Mundi vult decipi

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